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Care Home: Broomfield Grange Care Home

  • Broomfield Grange Care Home Court Road Chelmsford Essex CM1 7ET
  • Tel: tbc
  • Fax: tbc
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Broomfield Grange Care Home provides nursing and personal care for up to 140 people over the age of 65 including those with dementia.The home has four storeys that are separated into units and are accessible by four passenger lifts including a stretcher lift. All rooms are single with en suite facilities. There is a hairdressing salon for residents 0 140 and a coffee shop for use of visitors. Broomfield Grange is located adjacent to Broomfield District Hospital approximately half a mile from the village of Broomfield and near to Chelmsford with shops, market, library and recreational facilities. The hospital is accessible by public transport and Chelmsford is on the main London train route. The current weekly fee ranges from £550.00 to £850.00 per week. Additional charges/costs are incurred by residents relating to chiropody, hairdressing and personal items such as newspapers etc.

  • Latitude: 51.775001525879
    Longitude: 0.46399998664856
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 140
  • Type: Care home with nursing
  • Provider: European Care (Danbury) Ltd
  • Ownership: Private
  • Care Home ID: 19211
Residents Needs:
Old age, not falling within any other category, Dementia, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 22nd July 2009. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Broomfield Grange Care Home.

What the care home does well Broomfield Grange is a new purpose built care home that provides residential and nursing care for older people and those with a diagnosis of dementia. The home is a large care home provided on four floors. The premises are secure with door entry system in place. There is a coffee shop in the entrance of the home for use by visitors. The premises have been built to a high standard, are clean, well decorated, well furnished, well equipped and well maintained. All residents rooms are single en suite and one unit of the home has larger than average room sizes. The decoration and furnishings have been well thought out for the client group. For example the dementia units have been decorated and furnished to provide a calming atmosphere whereas the residential unit of the home has been furnished attractively with patterned carpeting and colourful furnishings and furniture. At the time of this inspection there were sixteen residents in the care home and staffing levels were appropriate for their needs. The premises are unitised with secure doors that enable residents who wander to feel unrestricted and there are various small seated areas throughout that enable them to rest when they need. The standards of personal care are good. Wet rooms/showers are available to enable residents to have as many showers as needed. One relative told us `x has had three or four showers today....nothing is too much trouble`. Independence is promoted by staff who encourage residents to mobilise and appropriate equipment is available to aid mobility. There are grab rails throughout the premises including shower rooms which have a number of grab rails to aid mobility. Equipment is provided to meet specific needs, for example hoists and slings for individual resident`s use. Profiling beds are provided in all rooms in one unit on the ground floor that is planned to accommodate residents with challenging dementia. A number of profiling beds are also available in the other units. There are carpets in some rooms and flooring in others and choices are accommodated as far as possible. There are large screen televisions provided in all communal lounges and individual rooms have television/dvd players. Staff were observed to interact well with residents and their relatives and to spend time with them. The home has a snoozelum room that is exceptionally well fitted with fibre optics, strobe lighting, `sparkle` mats etc used as therapy for residents displaying aggression/anxiety. Therapy boards are displayed throughout the walls of some units to enable residents to touch and feel different fabrics, furs, musical instruments and equipment (bolts). Assessment and care planning processes are robust with a person centred approach provided. Healthcare access is good. All residents are registered with a local GP who attends regularly and there is good monitoring of healthcare needs and prompt referral to a GP or district nurse as needed. Relatives/visitors informed us they are able to access the home at anytime. Some relatives who choose are able to assist with the care of their loved one. A large print programme of social activities on offer is on display. The home employs a full time activities coordinator who works shifts over seven days. Assisted by care staff and some relatives, this enables activities to be provided at weekends. A relative told us that games of bingo, painting and colouring sessions are organised. One resident spoken with was proud to have a wood carving on display which gave a point of interest for discussion with them. Although only open a few weeks, an outing had been arranged to Hylands House and photographs of this and residents enjoying ice cream were seen on display to remind them and promote conversation with staff and visitors. The standard of food is good with all food cooked on site and a full choice including hot food offered at breakfast, lunch and supper. Afternoon tea and evening snacks/sandwiches are provided. Small kitchens are provided in each unit for use by staff and visitors and for therapy for residents. A relative told us `I can make a cup of tea when I want and I feel comfortable doing so`. Dining rooms in each of the units have been furnished with four to five tables and chairs to provide more homely type facilities. Some issues have been identified but in the main, the standards for administration and recording of medicines is very good. Residents have a nutritional risk assessment on admission and those identified at risk are referred and prescribed nutritional supplements as relevant. The staff have been recently employed and teamwork is developing. Recruitment processes are robust with the required checks obtained prior to appointment provided. There is a training manager is post and a comprehensive programme of training in place. Staff induction is provided over three months and meets common induction standards. A relative told us that `staff are happy in their work. They are friendly and very nice with residents`. Recruitment is progressing on an incremental basis as more residents are admitted to the home. No more than one or two residents per week are admitted to the home enabling them to settle in and others to accept new residents. Staff have their own large staff room with drink making facilities, lockers and separate toilets and two showers enabling them to change at work. The manager operates an open door policy and is well known by relatives. Consultation evenings have recently been offered to enable relatives and staff to meet her on an individual basis out of hours. There are robust safeguarding procedures in place and evidence of a prompt response to any concerns or safeguarding issues. Staff are supported and involved in decision making. For example they have been consulted with to gain their views and help them understand how they are going to achieve the standard of care for residents with dementia. Staff are well supervised and individual supervision sessions have been planned. The manager also has regular meetings with senior management who visit regularly and comply with regulation 26 visits. There are systems in place to ensure that regular health and safety checks and fire safety checks are undertaken. The quality assurance programme is under development and regular audits are planned both internally and from a compliance team within the organisation. What has improved since the last inspection? This is the first inspection of this service. What the care home could do better: The standards for infection control were in the main good. However there was no liquid soap, paper towels or foot operated pedal bins in the laundry and shelving systems were not yet available to organise resident`s personal clothing before return to them. The sluice room for one unit was being used for storage of equipment and obstructed the mechanical sluice and there was no liquid soap or paper towels provided. One prescribed cream was not signed for on the MAR sheet as confirmation of having been given. The Controlled Drugs register included the name of the pharmacy but not address. This should be recorded both on receipt and disposal. There was no medication room temperature monitoring and the temperature of the room was 26 degrees Centigrade (recommended maximum 25 degrees centigrade). Key inspection report Care homes for older people Name: Address: Broomfield Grange Care Home Broomfield Grange Care Home Court Road Chelmsford Essex CM1 7ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Green     Date: 2 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Broomfield Grange Care Home Broomfield Grange Care Home Court Road Chelmsford Essex CM1 7ET tbc tbc Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Care (Danbury) Ltd Name of registered manager (if applicable) Mrs Sheila Anne Barwick Type of registration: Number of places registered: care home 140 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service: Care Home with Nursing - Code N To service users of the following gender:Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD The maximum number of service users who can be accommodated is: 140 Date of last inspection Brief description of the care home Broomfield Grange Care Home provides nursing and personal care for up to 140 people over the age of 65 including those with dementia.The home has four storeys that are separated into units and are accessible by four passenger lifts including a stretcher lift. All rooms are single with en suite facilities. There is a hairdressing salon for residents Care Homes for Older People Page 4 of 31 Over 65 0 140 0 140 0 140 Brief description of the care home and a coffee shop for use of visitors. Broomfield Grange is located adjacent to Broomfield District Hospital approximately half a mile from the village of Broomfield and near to Chelmsford with shops, market, library and recreational facilities. The hospital is accessible by public transport and Chelmsford is on the main London train route. The current weekly fee ranges from £550.00 to £850.00 per week. Additional charges/costs are incurred by residents relating to chiropody, hairdressing and personal items such as newspapers etc. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first inspection of the service. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This unannounced inspection took place on 22nd July 2009. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit. This would normally include the Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service and is a self assessment that focuses on how well outcomes are being met for people using the service. However the AQAA had not been requested by the Commission on this occasion. Care Homes for Older People Page 6 of 31 The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, their relatives, staff and the manager. The manager and staff were welcoming and helpful throughout the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: Broomfield Grange is a new purpose built care home that provides residential and nursing care for older people and those with a diagnosis of dementia. The home is a large care home provided on four floors. The premises are secure with door entry system in place. There is a coffee shop in the entrance of the home for use by visitors. The premises have been built to a high standard, are clean, well decorated, well furnished, well equipped and well maintained. All residents rooms are single en suite and one unit of the home has larger than average room sizes. The decoration and furnishings have been well thought out for the client group. For example the dementia units have been decorated and furnished to provide a calming atmosphere whereas the residential unit of the home has been furnished attractively with patterned carpeting and colourful furnishings and furniture. At the time of this inspection there were sixteen residents in the care home and staffing levels were appropriate for their needs. The premises are unitised with secure doors that enable residents who wander to feel unrestricted and there are various small seated areas throughout that enable them to rest when they need. The standards of personal care are good. Wet rooms/showers are available to enable residents to have as many showers as needed. One relative told us x has had three or four showers today....nothing is too much trouble. Independence is promoted by staff who encourage residents to mobilise and appropriate equipment is available to aid mobility. There are grab rails throughout the premises including shower rooms which have a number of grab rails to aid mobility. Equipment is provided to meet specific needs, for example hoists and slings for individual residents use. Profiling beds are provided in all rooms in one unit on the ground floor that is planned to accommodate residents with challenging dementia. A number of profiling beds are also available in the other units. There are carpets in some rooms and flooring in others and choices are accommodated as far as possible. There are large screen televisions provided in all communal lounges and individual rooms have television/dvd players. Staff were observed to interact well with residents and their relatives and to spend time with them. The home has a snoozelum room that is exceptionally well fitted with fibre optics, strobe lighting, sparkle mats etc used as therapy for residents displaying aggression/anxiety. Therapy boards are displayed throughout the walls of some units to enable residents to touch and feel different fabrics, furs, musical instruments and equipment (bolts). Assessment and care planning processes are robust with a person centred approach provided. Healthcare access is good. All residents are registered with a local GP who attends regularly and there is good monitoring of healthcare needs and prompt referral to a GP or district nurse as needed. Relatives/visitors informed us they are able to access the home at anytime. Some relatives who choose are able to assist with the care of their loved one. A large print programme of social activities on offer is on display. The home employs a full time activities coordinator who works shifts over seven days. Assisted by care staff and some relatives, this enables activities to be provided at weekends. A relative told us that games of bingo, painting and colouring sessions are organised. One resident spoken with was proud to have a wood carving on display which gave a point of interest for discussion with them. Although only open a few weeks, an outing had been arranged to Hylands House and photographs of this and residents enjoying ice cream Care Homes for Older People Page 8 of 31 were seen on display to remind them and promote conversation with staff and visitors. The standard of food is good with all food cooked on site and a full choice including hot food offered at breakfast, lunch and supper. Afternoon tea and evening snacks/sandwiches are provided. Small kitchens are provided in each unit for use by staff and visitors and for therapy for residents. A relative told us I can make a cup of tea when I want and I feel comfortable doing so. Dining rooms in each of the units have been furnished with four to five tables and chairs to provide more homely type facilities. Some issues have been identified but in the main, the standards for administration and recording of medicines is very good. Residents have a nutritional risk assessment on admission and those identified at risk are referred and prescribed nutritional supplements as relevant. The staff have been recently employed and teamwork is developing. Recruitment processes are robust with the required checks obtained prior to appointment provided. There is a training manager is post and a comprehensive programme of training in place. Staff induction is provided over three months and meets common induction standards. A relative told us that staff are happy in their work. They are friendly and very nice with residents. Recruitment is progressing on an incremental basis as more residents are admitted to the home. No more than one or two residents per week are admitted to the home enabling them to settle in and others to accept new residents. Staff have their own large staff room with drink making facilities, lockers and separate toilets and two showers enabling them to change at work. The manager operates an open door policy and is well known by relatives. Consultation evenings have recently been offered to enable relatives and staff to meet her on an individual basis out of hours. There are robust safeguarding procedures in place and evidence of a prompt response to any concerns or safeguarding issues. Staff are supported and involved in decision making. For example they have been consulted with to gain their views and help them understand how they are going to achieve the standard of care for residents with dementia. Staff are well supervised and individual supervision sessions have been planned. The manager also has regular meetings with senior management who visit regularly and comply with regulation 26 visits. There are systems in place to ensure that regular health and safety checks and fire safety checks are undertaken. The quality assurance programme is under development and regular audits are planned both internally and from a compliance team within the organisation. What has improved since the last inspection? What they could do better: The standards for infection control were in the main good. However there was no liquid soap, paper towels or foot operated pedal bins in the laundry and shelving systems were not yet available to organise residents personal clothing before return to them. The sluice room for one unit was being used for storage of equipment and obstructed the mechanical sluice and there was no liquid soap or paper towels provided. One prescribed cream was not signed for on the MAR sheet as confirmation of having Care Homes for Older People Page 9 of 31 been given. The Controlled Drugs register included the name of the pharmacy but not address. This should be recorded both on receipt and disposal. There was no medication room temperature monitoring and the temperature of the room was 26 degrees Centigrade (recommended maximum 25 degrees centigrade). If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live in Broomfield Grange can expect to receive sufficient information and to have an assessment to ensure their individual needs can be met prior to admission. Evidence: The home had a statement of purpose and service user guide that met regulatory requirements. Relatives spoken with during the visit to the service confirmed they had met with the manager prior to admission and had received sufficient information to enable them to make a decision. The admission procedures were discussed with the manager of the home. Referrals were accepted by telephone and information on care needs obtained including a copy of the community care assessment provided by the social worker. Prospective residents and /or their relatives were encouraged to visit the home and view the accommodation. A relative spoken with during the visit to the service confirmed they Care Homes for Older People Page 12 of 31 Evidence: had viewed the home and spent time with the manager who was very informative and told us she showed us around and was brilliant. We were informed that assessments were undertaken either in the persons own home, care home or hospital. A preadmission assessment was undertaken using a pre-assessment form as a prompt to discuss care needs. This included detailed guidance for staff on its completion in assessing key needs, for example pain, breathing, self care/level of dependence, communication, privacy/dignity, continence, skin integrity, safety and nutrition. Information was used following admission to complete a full assessment and care plan. Three residents care plans were viewed during the visit to the service. All included a very detailed pre-admission assessment form that provided key information on the residents care needs from which a care plan could be developed. A getting to know you form was provided to the family to complete. This was also very detailed and provided prompts for completion that supported the person centred approach and enabled staff to gain an understanding of the life history of the person, their likes and dislikes and meet their individual needs. The home does not provide intermediate care. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to have their health and personal care needs met through robust person centred care planning that is regularly reviewed. Evidence: The manager explained the care planning process which was based on person centred care planning and written in the first person. Three residents care records were viewed during the site visit. All three contained a pre-admission assessment detailing the residents care needs. Care plans were seen for personal care, emotional health and well being, sexuality, continence, eating and drinking and mobility. All three files viewed contained very detailed care plans that were written from the residents perspective in plain language, enabling the care assistant to understand the residents individual needs in order to provide appropriate care. For example, one care plan advised staff as follows my eye sight is very poor and I would like the staff to come close to me so that I can see them as I sometimes can only see the shape/outline even with my glasses on. Evidence of the residents or representatives agreement was seen in each of the care plans viewed. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken Care Homes for Older People Page 14 of 31 Evidence: monthly. Risk assessments were seen for risks associated with manual handling, use of bed rails, tissue viability and nutritional risk. All had been regularly reviewed ensuring that residents changing needs were assessed and that staff had information to be able to meet them. Daily records provided good detail of how the resident spent their day and recorded any changes in their condition or mood and the action that had been taken as a result. Residents access to healthcare services was discussed with the manager. Residents were all registered with a GP who visited the home on request. District nurses visited to provide treatment to residential residents. During the visit to the service district nurses were seen to visit the home. One residents care records viewed also confirmed they had received visits from their GP and district nurse, continence nurse, chiropodist, tissue viability nurse and had attended a physiotherapy appointment and a dental surgery for treatment. The medication systems were discussed with the manager and a registered nurse. Medication was administered by registered nurses and a list of staff signatures and initials was maintained to enable appropriate follow up in the event of an adverse incident. The home had a medication policy and procedures for staff guidance. Medication was supplied from the local supplying pharmacist in monitored dosage systems and individual containers. There were five medication rooms in the home with two being in use. Medication was stored on the ground floor and in the second floor residential unit. The medication for the residential unit was inspected. Appropriate procedures were in place for the receipt and disposal of medication that were seen to be well adhered to. Medication was stored in a clinical room and stored in a locked trolley that were secured to the wall. A drug refrigerator was also available and temperatures were monitored and recorded. However room temperatures were not recorded and monitored to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade).The medication storage and medicines administration records for four residents were examined. All medication was available as prescribed and records were recorded accurately apart from one omission of a prescribed cream. There was a cupboard for CD storage that met requirements and a CD register that was recorded accurately and in full with entries of the name and address made on receipt of CD drugs on discharge/disposal. Staff were observed to be friendly but respectful to residents during the visit to the home and to be courteous in their conversations with them. Residents spoken with confirmed that personal care was provided in private and from observation it was evident that efforts were made to maintain privacy. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event Care Homes for Older People Page 15 of 31 Evidence: that a resident chose to self medicate. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to be supported to maintain contact with their families and friends, to receive a well balanced and nutritious diet and to have a lifestyle that satisfies their cultural expectations, needs and capacities. Evidence: The home employed a full time activities coordinator who worked a shift pattern that enabled activities to be provided at weekends as well as Monday to Friday. A schedule of activities was seen on display and in large print enabling residents and their representatives to easily read it. Staff assisted the activities coordinator with the various activities on offer. We spoke with a relative who told us their loved one had enjoyed a game of bingo and playing with a ball and they had observed residents painting and colouring pictures and playing cards with staff. A gazebo was provided in the garden of the home to provide shelter for residents from the hot sun. We were informed that residents had been taken to Hylands House for the afternoon and a relative also confirmed this. Photographs were on display in the home of residents at Hylands House and enjoying an ice cream. We were informed that arrangements had been made with the hospital chaplain to give communion to residents. A representative of the catholic church also attended to give communion which was confirmed by a relative spoken with during the visit to the service. The home had a Care Homes for Older People Page 17 of 31 Evidence: snoozelum room was was exceptionally well fitted with a variety of fibre optic lights, sparkle mats, a projector and other equipment. This was used for individual residents to calm their mood and reduce their aggression. A wide variety of therapy boards were seen on display throughout the home. These included items such as various fabrics and furs for residents to feel and others were fitted with bolts and screw and musical instruments that residents were able to touch and fiddle with. We were informed that a getting to know you booklet was given to residents/representatives on admission. A copy was provided during the visit to the home. This included a range of forms for background information that residents with the assistance of a relative were requested to complete. This gave staff key information of the residents life, family, significant life events, hobbies, interests, likes and dislikes etc to inform person centred care planning. This ensured that staff were as informed as they could be about the individual, able develop a rapport with them and were therefore more equipped to meet their needs. The homes statement of purpose detailed the visiting arrangements for the home. The visitors book also provided evidence that numerous people visited the home. Several relatives were spoken with during the visit to the home and all confirmed they could visit during the day, evenings and at weekends. The manager also stated that she had recently arranged a programme of individual meetings during several evenings per week so that staff and relatives could have an opportunity to meet with her at different times which was particularly useful for people who worked during the day. During the visit to the home residents were observed to have a choice of where they ate their meals and how they spent their day. Some residents were seen to wander throughout the home and a number of seated areas were provided throughout to enable them to have a rest should they need to. Residents rooms were seen to be personalised with their own belongings (photos, pictures,ornaments etc.) Information on advocacy services was seen on display in the home and the statement of purpose contained details of advocacy services that could be arranged on behalf of residents. Care records included an advocacy plan review form that encouraged staff to document any communication or visits from family and or advocates acting on behalf of residents. The homes kitchen, viewed during the visit to the service was large and very well fitted, clean and well organised. Several heated trolleys were available for use to ensure residents meals were served hot. The menus were discussed with the manager and were seen to be rotated on a four weekly basis and were varied and nutritious. All Care Homes for Older People Page 18 of 31 Evidence: food was cooked on site with home made cakes and pastries also provided. The dining rooms in use had small tables to accommodate three to four residents, giving a homely feel and were nicely laid with cutlery, condiments etc. unless this posed a risk. Each of the units of the home had a small, well fitted kitchen that staff and relatives were able to access. The kitchens could also be utilised for therapy with residents washing and drying dishes. One relative told us that they could make a cup of tea when they wished and felt comfortable in doing so and said the food is very good here. During the visit to the home staff were observed serving hot and cold drinks throughout the day. The lunchtime meal comprised a choice of roast turkey with ratatouille and parmenter potatoes or a light lunch followed by a desert of cheesecake and cream. Afternoon tea was provided with cakes and sandwiches offered. Supper was a hot meal with a choice of jacket potato, sausage rolls and baked beans, soup and sandwiches or leek and potato pie. We were informed that sandwiches and snacks were also offered with residents late night drinks. Residents records viewed confirmed that a nutritional risk assessment was undertaken on admission to the home and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to have their concerns listened to and acted upon and to be protected by the homes policies, procedures and practices. Evidence: The home had a complaints procedure that was included in the statement of purpose and service user guide. A copy was also seen on display in the home. No complaints had been received either by the home or the Commission since the previous key inspection. The manager said that she operated an open door policy and was freely available for residents and their relatives should they have any concerns. Consultation evenings were now offered to relatives to enable them to meet individually with the manager to discuss any issues they may have. The home had safeguarding procedures in place and the records confirmed that all staff received training in safeguarding adults during the first weeks of employment. The manager stated that she had received adult protection training during her previous post in another local authority area. She also confirmed that the Essex safeguarding procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. There had been one safeguarding alert made since the home opened and from discussion with the manager and a social worker it was evident that procedures had been followed and appropriate action taken. The homes recruitment procedures were inspected and were confirmed to protect Care Homes for Older People Page 20 of 31 Evidence: residents by ensuring all relevant checks were undertaken prior to appointment. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to live in a clean, comfortable, well decorated and well maintained home that is equipped to meet their individual needs and disabilities but staff practices do not always ensure the risk of infection is minimised. Evidence: A tour of the premises was made during the visit to the home. The home was secure with a door entry system in place. There is a large reception area with tables and chairs and a coffee shop that can be used by visitors. Several administrative offices and a hairdressing salon are located off the entrance of the premises. The home has four floors that can be accessed by stairs and three lifts, including one stretcher lift. A 10 bed unit on the ground floor of the home was viewed. We were informed that the unit was to open as a challenging dementia unit but there were currently no residents. All rooms were large single en-suite/wet rooms with profiling beds in each. The nursing/dementia unit was also viewed and comprised two single 15 bedded units each with a dining room, assisted bathroom, small kitchen and sluice room. There were 12 residents in the two units. The third floor of the home was in use as a residential unit. There were currently four residents with and two designated staff. The fourth floor of the home comprised office accommodation, staff facilities and a large teaching/meeting room. Several residents rooms, communal rooms, bathrooms, a shower room, the kitchen and laundry were viewed. All accommodation was very Care Homes for Older People Page 22 of 31 Evidence: pleasantly decorated and furnished to a high standard. The home was clean and well maintained with no odorous smells. The home had a programme of maintenance in place with full-time maintenance staff employed. The gardens were laid to lawn and were accessible to residents and wheelchair users. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. The home had stairs and a three passenger lifts including a stretcher lift to enable access throughout the premises. There were grab rails in corridors and aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. A range of specialist pressure relief equipment was available to meet the needs of individual residents. This included individual slings for hoists to be used for residents with mobility needs. The home was clean with no malodorous smells evident. Systems were in place to ensure staff had personal protective clothing (liquid soap and paper towels) for use when providing personal care in residents en-suites and bathrooms. However there were no paper towels or liquid soap provided in the laundry room or a sluice room that was viewed. The laundry room was large with clean and dirty entrance/exits and was well equipped. There were four washing machines and three driers that were in working use, a rotary iron, standard iron and ironing table. Washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. We were informed that a laundry person would be recruited as the number of residents increased but that domestic staff and care staff currently shared laundry duties. Two relatives spoken with confirmed they were satisfied with the standard of laundry. A sluice room viewed on the ground floor of the home was observed to be full of equipment that obstructed access to the sluice disinfector and there were no paper towels or liquid soap to ensure staff were able to follow hand washing procedures and minimise the risk of infection. Piles of residents clean laundry was noted to be stored on top of a draining board and on a trolley posing a potential risk of infection. We were informed that staff had left the clothing there for night care staff to put away. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to be cared for by staff who are robustly recruited, well trained and employed in sufficient numbers to meet their needs. Evidence: The home had recently opened and there were sixteen residents. The manager said she planned to arrange the admission of new residents on an incremental basis to ensure their needs were carefully assessed, to reduce the impact on other residents and to ensure that staffing levels were appropriate to meet their needs (a recruitment programme for all staff was in process). We were informed that in addition to the manager, there were three administrative staff, a receptionist, a maintenance person, two domestic staff, two kitchen staff and a receptionist. A manager from another service was supporting the manager and a training manager was also on duty. The activities person was on leave. The duty rota was seen and confirmed the staffing levels were as discussed and appeared to meet residents needs. During the visit to the home, staff were noted to spend time interacting with residents who were all observed to be well cared for indicating that staffing levels were appropriate for their needs. We received the following comments during the visit to the home: the staff have so much patience; x is very helpful, nothing is too much trouble. No matter what x does x will always make the time; very happy with all the staff. Theyre helpful and Im kept well informed. Care Homes for Older People Page 24 of 31 Evidence: The manager informed us that there were a total of 23 care staff employed of which six had a NVQ level 3 qualification and two had an NVQ level 2 qualification. Five nurses from overseas who were working towards a diploma were also employed at the home. In addition there were two staff working towards an NVQ level 2 qualification and five working towards an NVQ level 3 qualification. This exceeds the recommended standard for 50 of staff to have an NVQ level 2 qualification. The recruitment files for five recently employed staff were viewed. All files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. The files also included staff contract/terms and conditions detailing their legal rights of employment. The home had a very comprehensive training programme that included mandatory training that was a requirement for all care staff (health and safety, manual handling, fire safety, first aid, COSHH, medication, food hygiene etc) and an extensive range of training to meet residents and staffs individual needs, for example dementia awareness, safeguarding adults, continence etc. Training on end of life care, person centred care, and palliative care was also planned. Staff were required to complete a competency framework to ensure they had understood the training and were competent. For example to follow procedures and safe practice when administering medication. The training records for one member of care staff were viewed and confirmed that they had undertaken a three month probationary induction period during which training had been provided in mandatory subjects, competencies assessed and was confirmed to meet the common induction standards. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broomfield Grange can expect to live in a well managed home with good standards of health and safety and practices that are well adhered to and protect them and staff. Evidence: Discussions were held with the recently appointed manager for the home who is a registered nurse with learning disabilities experience, an NVQ Assessor for Mentoring in Practice and holds the Registered Managers Award. The manager has several years experience of managing care homes and had been employed for some time by the organisation. The records viewed also provided evidence of updated training having been undertaken since the home opened. The manager was supported by the manager of another home employed by the same organisation. During the visit to the home it was clear that the manager was well known to residents and relatives. We also received the following comments from relatives from the moment we met Sheila we knew this was the right place, she is such a caring lady; Im very happy with the staff and those in the office. Theyre very helpful; she was brilliant. From observation Care Homes for Older People Page 26 of 31 Evidence: and an inspection of records, the home appeared to be well managed. The homes quality assurance policy and procedures were discussed with the manager. As a recently opened home this had not yet been established. However the manager was able to describe the organisations quality assurance programme, having managed two other care homes within the company. We were informed that health and safety audits are undertaken twice yearly and evidence of this was seen from the computerised records. This monitors the mandatory training undertaken by staff, staff welfare (stress, staff facilities, lone working, sickness and absence etc), policies and procedures in place and accidents and incidents. The manager said that she completes the audit and is assessed by a competency team who can visit unannounced to monitor compliance. A residents leaflet was also seen on display in the home requesting feedback to enable the quality of the service to be assessed and monitored.We were also informed that the organisation employed a dementia care specialist who had developed a dementia development programme An Introduction to Dementia/Supporting Excellence in Care for all managers to receive as part of their induction. The manager said that she had discussed the klora guidance on dementia with care staff to promote an open discussion how they were going to achieve these objectives. The arrangements for handling residents monies were discussed with the manager and an administrator. A policy and procedures were in place for staff guidance. Neither the manager nor representative were appointee for any resident. All residents had a relative or representative to manage their finances on their behalf. Personal allowances were held in secure facilities on their behalf. The personal allowances and records were inspected for four residents. The amounts of money were present and correct for all four with records of transactions made and receipts held as evidence. As the home had recently opened, a programme of staff supervision was not yet established. The manager said that a mentorship programme was under development and until staff were in post and mentors appointed, the training manager was acting as support/mentor to staff. Evidence of a three month assessment following the probationary period was seen in the staff files viewed together with planned dates for supervision. The home had a health and safety policy and procedures in place for staff guidance. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g.checks on fire Care Homes for Older People Page 27 of 31 Evidence: equipment, fire alarms and emergency lighting etc.). Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 A record should be made in the Controlled Drugs Register of the name and address on receipt and disposal of all controlled drugs. Administration of prescribed creams should be confirmed by signature when given. The medication storage room temperature should be monitored to ensure it remains within safe recommended levels (maximum 25 degrees Centigrade) To ensure the risk of infection is minimised residents clothing should not be stored in sluice rooms. To ensure the risk of infection is minimised paper towels and liquid soap should be provided in all key areas for staff hand washing including the laundry and sluice rooms. 2 3 9 9 4 5 26 26 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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